Final Blog Post
“What
are the applications of surgical robots today and are they more efficient than
human surgeons?”
This was the main question that made me choose this as my
topic for this project. I wanted to learn more about the safety, advantages /
disadvantages, as well as the future of surgical robots. Are they hurting or
helping the medical field?
My research started off with me discovering the “da Vinci
Surgical System” which is a robotic surgical system developed by the American
company Intuitive Surgical. This system was first introduced in 2000 after it
was approved by the FDA. It was originally designed to facilitate complex
surgery using a minimally invasive approach. This surgical system is the most commonly
used robotic surgical system in the world having 3,803 units worldwide. 2501 of
these units are in the United States alone and more hospitals are continuing to
implement them in their arsenal. The system as a whole has been criticized not
only for its cost, but more importantly the number of issues with its surgical performance.
How much does the “da Vinci Surgical System” cost?
The system ranges anywhere between the $1.5 million all the
way to $2 million and that is just the initial purchase cost. In addition to
the purchase price there are annual maintenance fees that are several hundred
thousand dollars as well as it costs $1500 per surgery to replaces the parts
used. Not only is it expensive to purchase but with the additional annual
maintenance fees and the surgery costs, the numbers add up fast for the
hospitals that have purchased this system.
The Advantages of the system:
The first advantage of robotic surgery under the “da Vinci”
system is that there is less scaring in comparison to normal surgery.
Specifically for Prostate Cancer surgery, standard surgery usually has an open
surgical incision that is around 5 to 6 inches long. Under the “da Vinci”
system patients will only have a series of small “band-aid” incisions. The
picture below is a visual representation of the surgical incisions comparing
standard surgery (Left) and with the “da Vinci” system (Right).
Due to the small incisions, not only is the pain
significantly less than it would be under standard surgery but the actual length
of the patients’ hospitalization is shorter. To clarify what I mean by
hospitalization, this is the time it takes for patients to return to usual
activity. The “da Vinci” system surgery is done in the morning and then
typically the patients are able to go home on that same day. In comparison,
standard surgery patients are required to stay at the very least two nights in the
hospital. In terms of discharge complications that happen following surgery,
robotic patients only have 5% - 10% while open surgery patients have up to 30%.
This difference of a 20% - 25% decrease when undergoing robotic assisted
surgery is extremely significant and is one of the many great advantages of the
“da Vinci” system.
The third and final advantage that I considered to be one of
the most significant is that less drugs are required and overall there
is less blood loss from robotic surgery under the “da Vinci” system. During
traditional open surgery, most patients lose anywhere between 600 cc and 1000
cc of blood loss. During robotic surgery, there is typically around 200 cc of blood
loss. Although the amount of blood loss does not matter for some patients the difference
in treatment approaches may be very important for some patients.
Disadvantages of the system:
The biggest disadvantage of the system is that most surgeons
that are using this system have not been given enough of the necessary training
and guidance to be considered proficient when using it. It is very common among
hospitals across the nation to see surgeons with not enough experience or
training with the “da Vinci” system that are undergoing potential life
threatening surgeries. This means that more lives could be at risk due to the
lack of training that is offered to these surgeons. Typically surgeons must
undergo as many as 50 practice surgeries before achieving real proficiency.
One of the most criticized aspects of the “da Vinci” is the
number of issues with its surgical performances. The FDA completed a 14 year
report that monitored over 1.7 million robotic procedures under the “da Vinci”
system. There were 10,624 “events” that were reported and then documented over
these 14 years. Of these “events” there were 114 deaths (1.4%), 1391 patient
injuries (13.1%), and the 8,061 device malfunctions (79.9%). Based off of these
statistics from the FDA report, the biggest issue with the system is device malfunctions.
The “da Vinci” system has been in operation for a long time now and that fact
that it still has so many device malfunctions is a problem. It needs to be
addressed and fixed or else people will never trust these systems.
The Future
From all of the research that I have done, the one thing
that surprised me the most is the lack of innovation of surgical robots like
the “da Vinci” system. It has been around for 17 years now and there has been
no surgical robots that compete with this system. Not only that but there has
been no update or renovation of the technology. There is talk of Google taking
the current “da Vinci” system and partnering with Johnson & Johnson to give
it an upgrade. Googles goal is to use different algorithms to be able to
analyze on screen images as well as highlight major blood vessels and have
critical information be easily accessible. Google will not be involved in
actually making the system but rather making the software for the system. They
want to make robot-assisted surgeries safer and I believe they are taking the
necessary steps to make this happen.
I believe that surgical robots like the “da Vinci” system have
taken on the role of being major stepping stones in the right direction for the
surgical robot field. The “da Vinci” system has shown the potential for
robotics in the medical field and how they can help make surgery more
efficient. Although there are many flaws with the system overall, there are
also many great benefits. I do not believe that the “da Vinci” system is
perfect by any means but it has been able to influence many other companies to
design their own robots for smaller applications. With continuous innovation of
the system which Google is trying to do, not only will surgeries by easier for
surgeons but they will be safer. It will take some time before the public eye
will accept the application of surgical robots due to their current state, but
with the direction that robotics are going I believe their opinions will
changes soon.
I found this article in the Atlantic. It's a "Pocket Guide to the Robotic Revolution: Sorting the good from the bad, the creepy from the adorable." It covers the spectrum over time. Pretty cool; not scientific, but a good reminder of how far (and creepy) we've come.
ReplyDeleteHere is another great source!! I was looking at the Diane Rehm site for another article and found this bombshell!! The show aired in 2015. You can listen or read the transcript. Also check out the links at the bottom. (Transcript is not the full show). How Artificial Intelligence And Robots Will Impact Jobs And How We Think About Work.
ReplyDeleteI really enjoyed your presentation about the Da Vinci robot and robotic surgery. I was not aware how sophisticated these robots were, and how precisely they are able to operate. I also thought it was interesting that these robots are close to 17 years old! With as much as technology has progressed since 2000, its almost surprising that no newer robots have come in and successfully overtaken the Da Vinci. I liked where you ended your presentation, discussing what the future holds for surgical robots, especially how you had mentioned the possibility of Virtual Reality or potential augmented reality. In all, a very interesting topic that was well presented.
ReplyDeleteArtificial Intelligence has always been a hot topic since recent years, the development of A.I. has penetrated to many industry, one of the major player which I believed is the healthcare industry. I was so impressed when you introduced us the Da Vinci surgical robots which has already existed for around 17 years, since I have not thought people has already started to test the possibilities to use robotic arm to help in surgery or maybe even replace human completely in the future.
ReplyDeleteWhat I think you did great is that you have plenty of data and resource to evident your topics. You showed us a difference between robotic patients and open patients in terms of the discharge of complications that may happen in following surgery. The numerical data were so clear that all of us could understand the advantage of the robotic surgery while most of us probably were first introduced to this topic.
What I probably like to digger further in-depth is about the future development of this robotic surgery. Since you have mentioned that Google is cooperating with Johnson & Johnson to build an assistant for deliver safer and more efficient surgery for patients. My question follows that with the development of computer vision will someday appear a robotic that could complete a surgery alone? Just curious. In overall, I think both of your presentation and final post delivered a very clear main point to us, and I am very glad to be introduced this application of artificial intelligence. Besides, I really like the structure of your final post, which helped me to follow your steps to explore the research that you have done so far. Thank you!
I really enjoyed your presentation on the medical application of AI. You presented yourself in a very clear way that was easy to understand. I especially enjoyed how you played a video of an actual AI-powered surgical robot. The video demonstration made it easier to understand the benefits of using AI in the operating room. I was surprised to learn that technologies like the DaVinci have been around for almost two decades! It really shows how many technological hurdles still need to be addressed before such devices are perfected. I found this really interesting article that provides another perspective to AI medical devices: https://www.oreilly.com/ideas/3-challenges-for-artificial-intelligence-in-medicine
ReplyDeleteHere is a very thorough screenshot of all the different types of robotics in healthcare, and it's attached to this article by the same name, published in 2016. Follow the green links for the different types of surgery robots. They compare the daVinci model, developed in 1995, to other surgery robots, starting on p. 491. Certainly a very exciting topic!
ReplyDeleteI know the article doesn't provide any images, but you can search on them by name to see what they look like, or see the references at the end of the article.
DeleteLike others commented, this was a great topic, but probably could have benefitted from a more thorough search of the literature. I found the article above from Google Scholar. Even this 2016 article was cited with a chapter from a book, entitled "Robotics in Surgical Techniques."
ReplyDeleteWith that said, I am glad you focused on surgical robotics. The field of AI applications in healthcare is huge, as you probably figured out.
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